1. Glenohumeral Dislocation: Class, Complications and Management August 21, 2003 Emergency XR Rounds Simon Pulfrey (with much gleaned from Dave Dyck)

2. Normal

3. Diagnostic Strategies 1- True AP

5. 2. Axillary

7. Transcapular or “Y” View

10. Post reduction:

11. Hill-Sachs

12. Post reduction

13. Bankhart

14. Complications of anterior glenohumeral dislocation and reduction Neurovascular – neuropraxic and recover in days-weeks Fractures –Hill-Sachs – 11-50% of ant dislocations. May be higher if consider minor compression fractures –Bankart – ant glenoid rim #. 5% of cases. –Avulsion # of greater tuberosity in 10-15%.

15. Complications of anterior glenohumeral dislocation and reduction Rotator cuff injury – 10-15% will have tear. Higher incidence in those >40yrs. Capsulolabral avulsions in those of younger years

19. Infraglenoid Dislocation + Hill-Sachs Fracture

21. Luxatio Erecta:

22. Luxatio Erecta 0.5% Usually axial load on abducted arm or indirect trauma Presents with 100-160 deg of abduction Humeral shafts lies parallel to spine of scapula (infglenoid lies against chest wall) Usually need ortho help Wary buttonhole problem

24. Posterior Dislocation: -trough sign. Reverse Hill-Sach# on ante-medial hh. -Lightbulb/drum stick

25. Posterior Dislocation Rare. 2%. Commonly missed (50%!) Seizures, fall on flexed and adducted arm, direct blow Deceptively normal-appearing AP XR Increased importance of clinical exam

27. Clinical Findings: Arm adducted and internally rotated The anterior shoulder is flat and the posterior aspect full Prominent coracoid The patient won’t allow abduction or external rotation

29. Rim sign : ant glenoid rim and articular surface of hh increased (usu>6mm)

30. Summary Reduce ASAP Wary neurovascular status, fractures & rotator cuff injuries Consider necessity of pre & post reduction films on an individual basis Know well three methods of reduction Suspect posterior dislocations in appropriate pts